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Create ethical cultures in all relationships

ETHICS MADE REAL

GORDON SELF

December 27, 2010

The long running television series M*A*S*H depicted the antics of medical personnel coping with the stress of overseas military service, often playing practical jokes on each other.

Treating countless battlefield casualties under substandard conditions and with minimal supplies required some form of levity given the tragedies the mobile hospital faced. The target of many jokes seemed to be death itself, as if by laughing at it, they could rob death of its sting.

However the many incidences of gallows humour on the show did not camouflage the ethical questions. Not infrequently did the show's characters struggle with triaging whom to save, exercising conscientious objection, or acquiring much-needed medicines on the black market. Use of humour did not lessen the impact of these questions, but perhaps made them a little more accessible.

Our appetite for comic relief in health care has obviously not let up, judging by what's available on the Internet today. The admittedly funny but revealing conversations pitting one group of clinicians "versus" another on a popular YouTube site are just one example. The two professionals talk at, not to each other, focusing on their separate tasks and agenda rather than the patient's overall needs.

CRITICAL COMMUNICATION

We join in on the laugh seeing how readily misunderstanding can occur if we only focus on one aspect of the patient experience, and end up working at cross purposes from each other. More alarming is the risk of a medical error occurring should key messages between clinicians become "lost in translation." That is no laughing matter.

At Covenant Health, our code of conduct stipulates that we "keep the people we serve at the centre of all we do." Over the years there have been other similarly worded health care campaigns in this country raising the banner of person-centred care.

Given the increasing specialization of medicine and the complex interdependence of so many people involved in a single person's care, it is understandable that different stakeholders will hold different views as to what is best for patient or resident care, setting up similar scenarios to those parodied on the Internet.

While there are many integral parts of a larger health care system, the person in our care is an integral whole and must be treated as such.

MINISTRY OF SERVICE

Those of us who have had the privilege of working with the Sisters in Catholic health care know there was never any doubt in their mind about whom came first, and the impeccable standards owed patients and residents. The Sisters needed no reminder as they understood, at a foundational level, that theirs was a ministry of service.

That same commitment applies to those of us who today carry on the healing ministry of Jesus. While there will always be system level pressures in health care, including competing priorities and agendas among different health care disciplines, there is no excuse for putting people at risk by not seeking collaborative solutions.

In order to advocate for those we serve, we are morally obligated to work together. Keeping the people we serve at the centre of all we do remains only a nice slogan unless we give equal weight to another statement in our code of conduct - "seek to resolve and diffuse conflict at the appropriate level."

A clinician recently told me about a disagreement with a colleague that could have been easily nipped in the bud had they discussed the matter among themselves before others got involved.

Regardless where we work or gather as community, conflict with others is inevitable, conflict that can result in a break down in communication. What is not so predictable is how well the community will respond by working through conflict directly and respectfully with others.

While social media sites have plenty of material to poke fun at human behaviour, the challenge is whether we are committed to continuously improving relationships with others to create the ethical culture we desire. Or do we just laugh along and settle for mediocrity?

There were plenty of laughs on M*A*S*H certainly, but the humour served to point viewers to what is possible; to uphold an ethical life, not mock it.

GO FORWARD

In this liturgical season we celebrate the coming of the Divine Light into the world. We are called to make Christ the centre of our lives, and to share his healing love with others. Grounded in love, enlightened by faith, and sometimes disarmed through the gift of humour, we are able to name the ethical issues of our times and commit to finding a way forward.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached atmes@covenanthealth.ca.)